Facelift Seattle - Sam Naficy, MD - Face lift, Neck lift, Eyelid lift, Brow lift in Seattle, WA

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Dr. Naficy

Facelift Surgery

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Announcement

FACE LIFT RECOVERY

Seattle, WA - Face lift recovery. Most patients are pleasantly surprised to hear that recovery from a facelift can be quite brief. Seattle facial plastic surgery expert, Dr. Sam Naficy, performs a number of innovative and minimally-invasive face lift and neck lift procedures with recovery times as brief as just a few days. Read more about the recovery here......

Announcement

THE FEATHERLIFT TECHNIQUE - As seen on Oprah

Seattle, WA - Facial plastic surgery without the scalpel!?
See how you can turn back years in just minutes with the exciting Featherlift procedure. "The Featherlift (also known as Feather lift, Thread lift, Suspension lift, and Contour lift) is quicker and more predictable than Thermage", states the Seattle Plastic Surgeon. "Combined with Botox, Restylane, Fat injections, or Sculptra, you can get the younger face you want without the down-time or expense of facial plastic surgery." Read more about the Featherlift procedure......

Announcement

DR. SAM NAFICY VOTED TOP FACIAL PLASTIC SURGEON

Seattle, WA - Face lift, neck lift specialist.
Voted "Top Doctor" by his medical peers in facial plastic surgery
Seattle Magazine

Patient Registration

On your first visit, you will need to complete a registration form and a medical history form. For your convenience, you may provide this information by filling out the online version of these forms below. Your information will be emailed to us at our office. If you prefer not to have your information sent by email, you may elect to download and complete the registration form and the medical history form and bring hard copies with you on the day of your visit.

Last Name:

First Name:

Middle Initial:

Mr. Mrs. Miss Ms. Dr.

Date of Birth (mm/dd/yyyy) :

Address:

Street Address
City, State, Zip

Home Phone:

Work Phone:

Cell Phone:

Email:

Patient's Employer:

Patient's Occupation:

Marital Status:
Single Married
Widowed Separated Divorced

Spouse's Name:

Spouse's Employer:

Spouse's Occupation:

Person Responsible for Bill - Insurance Guarantor

Patient's relationship to person responsible for bill:
Self (skip to next section)
Spouse
Child
Dependent

Last Name:

First Name:

Middle Initial:

Address:

Street Address
City, State, Zip

Home Phone:

Work Phone:

Insurance Information

Primary Insurance:

Secondary Insurance:

Emergency Information and Release

In case of an emergency, local friend or relative to be notified
(not living at same address):

Name:

Relationship to Patient:

Home Phone:

Work Phone:

May we contact you to remind you about upcoming or missed appointments?
Yes No

Please provide your preferred contact phone number or email

Would you like to be excluded from mailings and email promotions?
Yes No

If you have any specific cosmetic interests, please check all that may apply:

Surgical:	Non-Surgical:
Face Lift	Botox
Mini Face lift	Restylane
Neck Lift	Sculptra
Neck Liposuction	Radiesse
Nose Reshaping	Juvederm
Brow Lift	Perlane
Eyelid Lift	Artefill
Cheek Lift	Fotofacial
Chin Implant	Intensive Fotofacial
Cheek Implant	Polaris for Wrinkles & Tightening
Feather Lift	Thermage for Face
Laser Resurfacing	Thermage for Body
Fat Injection	Treatment of Age Spots/Freckles
Lip Augmentation	Laser Vein Removal
Ear Reshaping	Laser Hair Removal
Buccal Fat Removal	Mesotherapy & Lipotherapy
Scar Revision	Non-Surgical Body Lifting
	Microdermabrasion
	Retinoic and Glycolic Peel

Please answer the following questions on a scale of 1 to 5:

When looking at my face in the mirror, I believe I look younger, the same as, or older than my true age.

Younger Than		True age		Older Than
1	2	3	4	5

When looking at my face in the mirror, the appearance of my face makes me:

Not Concerned		Somewhat Concerned		Very Concerned
1	2	3	4	5

I am looking for a procedure that can give me a:

Small improvement with minimal down-time		Moderate improvement with some down-time		Significant improvement with longer down-time
1	2	3	4	5

How did you hear about us?
(Check all that apply)

My physician
          (full name)
The yellow pages/telephone book
A friend or family member
          (name)
          May we contact him/her?   Yes    No
          Phone or Email:
Seattle Magazine's TOP DOCTORS
Internet search
          (Google, Yahoo, Other)
Online referral network
          (facialplasticsurgery.net, Other)

Newsletter or mailer
An article or advertisement in

Email this page

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